Waterpipes and pint glasses: A mixed methods study on hookah and alcohol concurrent use among young adults

Hookah tobacco smoking continues to increase in popularity among young adults in the United States. Researchers have reported hookah smoking at higher rates than cigarette smoking among some samples. As hookah use gains popularity, alcohol use also remains highly prevalent among young adults. Given the known connections between traditional forms of tobacco use and alcohol use, it is important to understand if hookah smoking and alcohol use have a similar connection. We conducted six focus groups with 40 young adults who had smoked hookah in the past three months to identify words and phrases associated with hookah use. After the focus groups, participants completed a survey on behaviors, attitudes, and beliefs related to hookah smoking, alcohol use, and other forms of tobacco use. Of these hookah smokers, 85% reported alcohol use in the past two weeks and 70% reported binge drinking in the past two weeks. Nearly three quarters of the participants reported drinking alcohol while they smoked hookah. Many (41%) indicated they preferred to smoke hookah while also drinking alcohol. During the focus groups, participants reported concurrent use of alcohol and hookah in order to get a stronger buzz or high, feel more relaxed, or have a more fun experience.  Our findings suggest that alcohol use is common and appealing among hookah smokers. Future research should investigate which populations are at greatest risk for hookah and alcohol concurrent use and whether combining hookah and alcohol increases the risk for negative health outcomes from either or both products.